Trapman Episode 6: The Rift in Reality

The patient was managed successfully with dual endovascular access and stent placement across the aneurysm, with a subsequent complete symptomatic relief. Description of the endovascular management of sigmoid sinus aneurysm is not infrequent in the literature. This report provides a brief review of the available literature specifically addressing the management strategies. The specific clinical feature of mastoidities that developed in a patient presenting with chicken pox was the rapid progress in temporal bone destruction with partial thrombosis of the sigmoid sinusis in the absence of typical manifestations of mastoiditis.

The pronounced destructive changes found in a series of CT images were regarded as the indications for urgent antromastoidotomy with the puncture of the sigmoid sinusis. A finite mixture of two Weibull distributions for modeling the diameter distributions of rotated- sigmoid , uneven-aged stands. The rotated- sigmoid form is a characteristic of old-growth, uneven-aged forest stands caused by past disturbances such as cutting, fire, disease, and insect attacks.

The diameter frequency distribution of the rotated- sigmoid form is bimodal with the second rounded peak in the midsized classes, rather than a smooth, steeply descending, monotonic curve. In this study a Resection and primary anastomosis with or without modified blow-hole colostomy for sigmoid volvulus. To evaluate the efficacy of resection and primary anastomosis RPA and RPA with modified blow-hole colostomy for sigmoid volvulus.

From March to September , 77 patients with acute sigmoid volvulus were treated. The clinical course and postoperative complications of the two groups were compared. The mean hospital stay, wound infection and mortality did not differ significantly between the groups. Anastomotic leakage was observed only in group A, with a rate of 6. The difference was numerically impressive but was statistically not significant. RPA with modified blow-hole colostomy provides satisfactory results.

It is easy to perform and may become a method of choice in patients with sigmoid volvulus. Further studies are required to further establish its role in the treatment of sigmoid volvulus. Primary non-Hodgkin's lymphoma of the sigmoid colon in a child. Primary non-Hodgkin's lymphomas of the gastrointestinal tract are rare in children, and few of these lymphomas are located in the sigmoid colon. The preoperative diagnosis rate is low. Complete resection is indicated if it can be done safely. Combination chemotherapy after resection is indicated. Comparative study of collagen deposition in the colon wall of patients operated for sigmoid diverticular disease.

To investigate the deposition of collagen in the colon wall of patients with sigmoid diverticulitis. Samples of sigmoid tissue from 15 patients disease group , seven men and eight women aged years who underwent surgery for the treatment of diverticulitis, were selected. For the control group, specimens from five patients, three men and two women aged years undergoing emergency surgery for sigmoid trauma were selected.

These subjects had no associated diseases. The histological study of the surgical specimens was performed by staining with hematoxylin-eosin and picrosirius and using a histochemical method for collagen quantification. In this study, collagen deposition in the colon wall of the patients operated for sigmoid diverticulitis was higher compared to patients without the disease. Neoplastic sigmoid -uterine fistula. An exceptional complication of large intestine cancer.

Neoplastic sigmoid -uterine fistula is an extremely rare condition because the uterus is a thick and muscular organ. A year-old woman was admitted to the First Aid Station suffering from abdominal pain and foul smelling vaginal discharge. Gynaecological examination showed fecal drainage from the cervical orifice, while the uterus was regular in size but very firm and painful. Ovaries and fallopian tubes were not palpable owing to abdominal tenderness. Ultrasounds reveled inhomogeneous thickening of uterine cavity, without detecting fistula.

The sigmoid wall was very thin exception a site where a fistula was suspected. At the surgery severe adhesions of the sigma-rectum with the posterior uterine wall were observed. After adhesiolysis, 18 cm colon-sigma-rectum was removed. Total hysterectomy with salpingooophorectomy was performed.

Lymphadenectomy ended the procedure. Anatomical specimen confirmed sigmoid -uterine fistula. At histology a mildly differentiated adenocarcinoma of sigma-rectum was shown. Such a case of neoplastic sigmoid -uterine fistula has not been reported so far. Large CMEs most often have filaments that erupt with them.

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This study focuses on the statistical relevance of the shape of the sigmoid and the chirality of the filament residing in these sigmoids. The study further extends to the relation between the directionality of filaments and the Earth-directed CMEs. Sigmoid data from Savcheva et al. Hence this dataset consists of almost one solar cycle of data. A similar study done previously by Martens et al. Considering that automated chirality detection is not foolproof, we present this study which uses manual determination of chirality for accuracy using high resolution chromospheric images.

A comparison of the analysis of the chirality of filaments using both data will be presented. Although KSO gives a 4k resolution, it is still difficult to determine the chirality of small filaments. The results of the comparison using the different resolutions are shown. The results of the correlation.

To study the clinical effect of laparoscopic vaginoplasty using pedicled ileal and sigmoid colon segment. From January to December , cases undergoing laparoscope-assisted vaginoplasty using a vascularized pedicled intestinal flap were studied retrospectively. Operation time, blood loss in operating, bowel movement after operation, postoperation hospital duration, side effect, and artificial vagina were compared between two surgical management.

The vaginoplasty were preformed successfully in all cases. There were 48 patients treated by aparoscope-assisted ileal vaginoplasty and 57 patients treated by laparoscope-assisted sigmoid colon vaginoplasty. At follow-up of months, all artificial vaginas had a capacity of over two fingers in wideness and cm in length. Fifty-five patients with sexual intercourse reported satisfactory results.

Six patients complained vaginal stenosis: Laparoscope-assisted vaginoplasty using pedicled ileum or sigmoid colon segment are both the effective ways in forming vagina. The latter management takes more time and blood loss while operating, yet the. The patient was a 40's man who was diagnosed with sigmoid colon cancer with liver metastasis. Colonoscopy revealed a type 2 tumor with stenosis in the sigmoid colon. The liver tumor was sufficiently reduced, and laparotomy and liver right lobectomy were performed. Histopathology revealed a modified, Grade 2 tumor regression.

He has been followed for 1 year 4months after the operation. Wandering spleen, gastric and pancreatic volvulus and right-sided descending and sigmoid colon. Wandering spleen is a rare condition, characterized by a mobile spleen that is attached only by an elongated vascular pedicle, allowing it to migrate to any part of the abdomen or pelvis. Mesenteroaxial gastric volvulus usually occurs in children and may be associated with wandering spleen. Both entities result from abnormal laxity or absence of the peritoneal attachments due to abnormal fusion of the peritoneal mesenteries.

Pancreatic volvulus is a very rare anomaly, with only a few isolated case reports described in association with wandering spleen. Anomalous right sided descending and sigmoid colon is a very rare entity and its association with wandering spleen has not been previously reported. We report a case of wandering spleen associated with mesenteroaxial gastric volvulus, pancreatic volvulus and rightward shift of the splenic flexure of the colon and right sided descending and sigmoid colon in a young female.

Gonorrhoea of the sigmoid neovagina in a male-to-female transgender. A year-old male-to-female transgender consulted our outpatient clinic with perneovaginal bleeding during and following coitus. Four years before, she underwent a total laparoscopic sigmoid neovaginoplasty. Physical, histological and endoscopic examination revealed neither focus of active bleeding nor signs of active inflammation.

A polymerase chain reaction test performed on a neovaginal swab showed gonococcal infection. Three weeks later, our patient reported resolution of symptoms, consistent with eradication of the infection demonstrated by a follow-up neovaginal swab polymerase chain reaction. To our knowledge, this is the first case report of gonococcal infection of the sigmoid neovagina. An efficient piecewise linear approximation of a nonlinear function PLAN is proposed.

This uses simulink environment design to perform a direct transformation from X to Y, where X is the input and Y is the approximated sigmoidal output. This PLAN is then used within the outputs of an artificial neural network to perform the nonlinear approximation. The major benefit of the proposed method resides in the possibility to design neural networks by means of predefined block systems created in System Generator environment and the possibility to create a higher level design tools used to implement neural networks in logical circuits.

Infrared small target enhancement: Infrared IR small target enhancement plays a significant role in modern infrared search and track IRST systems and is the basic technique of target detection and tracking. In this paper, a coarse-to-fine grey level mapping method using improved sigmoid transformation and saliency histogram is designed to enhance IR small targets under different backgrounds. For the stage of rough enhancement, the intensity histogram is modified via an improved sigmoid function so as to narrow the regular intensity range of background as much as possible.

For the part of further enhancement, a linear transformation is accomplished based on a saliency histogram constructed by averaging the cumulative saliency values provided by a saliency map. Compared with other typical methods, the presented method can achieve both better visual performances and quantitative evaluations.

Grave's disease with transverse and sigmoid sinus thrombosis needing surgical intervention. Thrombosis of venous sinuses associated with thyrotoxicosis is rare, and isolated transverse and sigmoid sinus thrombosis is rarer and reported only once previously. We present a case of Graves disease, who suffered unilateral sigmoid and transverse sinus thrombosis with intracranial hemorrhage. A year-old female, a diagnosed case of Graves disease, presented to us with headache, drowsiness, and hemiparesis. Computed Tomography revealed a large right temporo-parieto-occipital venous infarct.

The patient needed surgical intervention in the form of decompressive craniotomy following which she improved, and on follow-up is having no deficits. Deranged thrombophilia profile in combination with the hypercoagulable state in thyrotoxicosis, most likely precipitated the thrombotic event.

Timely surgical intervention can be offered in selective cases with a good clinical outcome. Perforation of a malignant ovarian tumor into the recto- sigmoid colon. Ovarian cancer often presents at an advanced stage, but tends to be an intra-peritoneal disease that respects peritoneal planes. Thus, colo-rectal perforation of the tumor is an extremely rare presentation. The surgical treatment of malignant colo-ovarian fistula should include complete cyto-reduction at the same time as the treatment of the fistula.

However, prognosis remains poor, because of the advanced stage of neoplasia. We report the case of a patient with an ovarian malignant tumor perforating into the recto- sigmoid colon. CT scan was the cornerstone of the radiological diagnosis. We managed to perform a complete cyto-reduction, including an en-bloc resection of the uterus, the mass, adnexa and recto- sigmoid with removal of the associated pelvic abscess.

Tubular sigmoid duplication in an adult man: A year-old man attended an outpatient colorectal clinic for a chronic, non-specific abdominal pain, associated with rectal bleeding. This case is interesting because tubular sigmoid duplication is an extremely unusual condition, rarely diagnosed in adults; only a few cases have been reported of this condition in the adult population. Our team chose to treat this patient conservatively, in order to avoid putting the patient at risk of an unnecessary surgery.

No commercial use is permitted unless otherwise expressly granted. Characterization and autoradiographic localization of neurotensin binding sites in human sigmoid colon. Radioiodinated neurotensin I-NT was used to characterize and localize NT binding sites in normal human sigmoid colon. Specimens were obtained from patients years old undergoing resection for colon carcinoma. Specific binding of I-NT to sigmoid circular muscle membranes was enhanced by o-phenanthroline 1 mM but other peptidase inhibitors were ineffective.

In autoradiographic studies, dense specific binding of I-NT was seen over myenteric and submucosal ganglia, moderate binding over circular muscle, and sparse binding over longitudinal muscle and taenia coli. Levocabastine, which has affinity for the NT2 receptor, did not inhibit specific binding of I-NT in membrane competition or autoradiographic studies. NT contracted sigmoid colon circular muscle strips with a pD 2 value of 6. The contractile responses to NT were significantly potentiated in the presence of tetrodotoxin 1 microM , indicating a neural component.

Results from functional studies support actions for NT on both muscle and enteric neurons, consistent with the presence of NT receptors on circular muscle and ganglia of human sigmoid colon. The lack of inhibition by levocabastine suggests that the second binding site detected does not correspond to the NT2 receptor. Elective laparoscopic recto- sigmoid resection for diverticular disease is suitable as a training operation. Some authors state that elective laparoscopic recto- sigmoid resection is more difficult for diverticular disease as compared with malignancy.

For this reason, starting laparoscopic surgeons might avoid diverticulitis, making the implementation phase unnecessary long. The aim of this study was to determine whether laparoscopic resection for diverticular disease should be included during the implementation phase.

All consecutive patients who underwent an elective laparoscopic recto- sigmoid resection in our hospital for diverticulitis or cancer from to were analysed. A total of consecutive patients were included in this prospective cohort study. One hundred and fifty-one patients were operated on for diverticulitis and for cancer. There was no significant difference in operation time vs.

The occurrence of anastomotic leakages was associated with higher American Society of Anesthesiologists ASA classification, which differed between the groups The antibacterial activity of chlorhexidine digluconate against Streptococcus mutans biofilms follows sigmoidal patterns. The aim of this study was to determine the pattern of the antibacterial activity of chlorhexidine digluconate CHX against mature Streptococcus mutans biofilms. After the treatments, the colony-forming unit CFU counts of the treated biofilms were determined.

The pH values of the spent culture medium were also determined to investigate the change in pH resulting from the antibacterial activity of CHX. The relationships between the concentration of CHX and the CFU counts and the concentration of CHX and culture medium pH, relative to the number of treatments performed, were evaluated using a sigmoidal curve-fitting procedure. The sigmoidal curves were left-shifted with increasing number of treatments. Furthermore, the culture-medium pH of the treated biofilms increased as their CFU counts decreased. The lowest CHX concentration to increase culture-medium pH above the critical pH also decreased as the number of treatments increased.

These results may provide fundamental information for selecting the appropriate CHX concentrations to treat S. Simultaneous development of ulcerative colitis in the colon and sigmoid neovagina. Vaginoplasty using sigmoid colon is a common technique for creation of a neovagina. However, special consideration must be given to potential long term consequences of using a colonic conduit for vaginal replacement.

We report on the youngest described case in which a patient developed ulcerative colitis refractory to medical therapy with simultaneous involvement of a sigmoid neovagina requiring total proctocolectomy and neovaginectomy. A 17 year old XY female with a history of gonadal dysgenesis and sigmoid graft vaginoplasty presented with a history of bloody, mucoid vaginal discharge, abdominal pain, bloody diarrhea and weight loss.

Colonic and neovaginal biopsies demonstrated active colitis with diffuse ulcerations, consistent with ulcerative colitis. Despite aggressive immunosuppressive treatment she had persistent neovaginal and colonic bleeding requiring multiple transfusions, subtotal colectomy and ultimately completion proctectomy and neovaginectomy. It is imperative to recognize that colectomy alone may be an inadequate surgical intervention in patients with ulcerative colitis and a colonic neovaginal graft and that a concomitant neovaginectomy may be integral in providing appropriate treatment.

To report our experience with solo-surgeon, single-port laparoscopic anterior resection solo SPAR for sigmoid colon cancer. In the solo surgeries, making the transumbilical incision into the peritoneal cavity was facilitated through the use of a self-retaining retractor system. After establishing a single port through the umbilicus, an adjustable mechanical camera holder replaced the human scope assistant. Patient and tumor characteristics and operative, pathologic, and postoperative outcomes were compared.

The operative times and estimated blood losses were similar for the patients in both treatment groups. In addition, most of the postoperative variables were comparable between the two groups, including postoperative complications and hospital stays. In the solo SPAR group, comparable lymph nodes were attained, and sufficient proximal and distal cut margins were obtained. This study shows that solo SPAR, using a passive camera system, is safe and feasible for use in sigmoid colon cancer surgery, if performed by an experienced laparoscopic surgeon. In addition to reducing the need for a surgical assistant, the oncologic requirements, including adequate margins and sufficient lymph node harvesting, could be fulfilled.

Further evaluations, including prospective randomized studies, are warranted. Invading of intrauterine contraceptive device into the sigmoid colon through uterine perforation caused by a blunt trauma. Intrauterine contraceptive device IUCD is relatively safe but still with some serious risks.

Uterus perforation is rare and would be fatal. A case of Cu-7 IUCD invading into the sigmoid colon through uterine perforation caused by a pelvic blunt trauma was presented. Our case showed that uterus perforation by an IUCD could induce utero- sigmoid fistula which is likely to be missed. Imaging is required when the patients with IUCD present abdominal pain, particularly with a history of trauma. Pulsatile tinnitus is experienced by most patients with idiopathic intracranial hypertension. Stereo x-ray photogrammetry applied for prevention of sigmoid -colon damage caused by radiation from intrauterine sources.

Radiation therapy of cervix carcinoma is applied in this Institute by means of modified Stockholm method in combination with external beam irradiation. This resulted in a marked increased incidence of serere sigmoid -colon radiation lesions from 0. Therefore two measures have been introduced: When SRM data indicated that a high dose at the sigmoid -colon might occur, treatment modifications enabled prevention of radiation damage.

Change of position of the applicator was the first to be considered. In the last seven years no surgical intervention had to be performed because of a sigmoid -colon lesion resulting from an unexpected high radiation dose delivered by intrauterine sources. The local recurrence rate was not increased following treatment modifications for prevention of sigmoid -colon radiation damage.

In sub-Saharan Africa, sigmoid volvulus is a frequent cause of bowel obstruction. The aim of this study was to evaluate the results of acute sigmoid resection and anastomosis via a mini-laparotomy in patients with uncomplicated sigmoid volvulus, following the principles of "Enhanced Recovery After Surgery ERAS ", in a low-resource setting.

Patients with uncomplicated sigmoid volvulus were operated acutely, via a mini-laparotomy, according to the principles of ERAS. Intraoperative complications, duration of operation, morbidity, mortality and length of hospital stay were evaluated, retrospectively. From 1 March to 1 September , 31 consecutive patients were treated with acute sigmoid resection and anastomosis, via a mini-laparotomy. Patients were operated after a median period of 4 range 1. The median duration of the operative procedure was 50 range minutes. Two patients died 6. One patient died during an uncomplicated operation.

The cause of death is unknown. One patient with a newly diagnosed HIV infection had an anastomotic dehiscence. After Hartmann's procedure, he died on the 17th post-operative day as a result of a HIV-related double-sided pneumonia, without signs of abdominal sepsis. One patient had an urinary retention and 1 patient haematuria after bladder catheter insertion. Acute sigmoid resection and primary anastomosis via a mini-laparotomy for uncomplicated sigmoid volvulus, without preoperative endoscopic decompression is a safe procedure with a low morbidity and mortality.

Sigmoid cancer versus chronic diverticular disease: To retrospectively identify morphologic findings at computed tomographic CT colonography that are the most reliable in the differentiation of masslike chronic diverticular disease from sigmoid carcinoma in a large patient cohort.

This study was approved by the institutional review boards. The need for signed consent was waived for this retrospective study. CT colonography studies were scored according to presence or absence of potential discriminators by a panel of four readers in consensus. Sensitivity, specificity, positive predictive value PPV , negative predictive value NPV , and accuracy were calculated, and multivariate analysis was performed. Also, shoulder phenomenon showed a high NPV 0.

Segment length of 10 cm or less NPV, 0. Although segments affected by carcinoma often showed straightened and eccentric growth patterns, no thick fascia sign, and more and larger local-regional lymph nodes all P Incomplete Neutralization and Deviation from Sigmoidal Neutralization Curves for HIV Broadly Neutralizing Monoclonal Antibodies.

The broadly neutralizing HIV monoclonal antibodies bnMAbs PG9, PG16, PGT, and PGT have been shown earlier to occasionally display an unusual virus neutralization profile with a non- sigmoidal slope and a plateau at sigmoidal slopes and plateaus at sigmoidal neutralization curves are possible for all HIV bnMAbs against a wide range of viruses produced and assayed in both cell lines and primary cells with implications for the use of antibodies in therapy and as tools for vaccine design.

Rupture of abdominal aortic aneurysm into sigmoid colon: Primary aorto-colic fistula is rarely reported in the literature. Although infrequently encountered, it is an important complication since it is usually fatal unless detected. Primary aorto-colic fistula is a spontaneous rupture of abdominal aortic aneurysm into the lumen of the adjacent colon loop. Here we report a case of primary aorto-colic fistula in a year old male. The fistulated sigmoid colon was repaired by end-to-end anastomosis. Despite inotropic support, the patient died of sepsis and multiorgan failure on the first postoperative day.

Submucosal lipoma of the sigmoid colon as a rare cause of mucoid diarrhea: Symptomatic presentations of colonic lipomas are very rare in clinical practice, and may mimic colonic malignancy. The likelihood of presenting symptoms has been shown to depend on the size of the lesion. We describe the case of a year-old Sinhalese man presenting with worsening mucoid diarrhea who was subsequently diagnosed to have a lipoma of the sigmoid colon.

His disease was successfully managed with endoscopic resection. Confidently establishing the rare diagnosis of a colonic lipoma usually requires a combination of endoscopic, radiological, and histological evaluation, and is therefore very challenging. With the advancement of endoscopic procedures, endoscopic resection is widely practiced as the definitive management of these cases.

Segmental dilatation of sigmoid colon in a neonate: Segmental dilatation of the colon is a rare disorder of colonic motility in children, often presenting with severe constipation in older infants, children, and occasionally adults. It may mimic the commoner Hirschsprung disease clinicoradiologically but differs in that the ganglion cell morphology and distribution are typically normal in the colon. We report a neonate with segmental dilatation of the sigmoid colon who had an atypical clinical presentation and describe certain abnormalities in bowel histology hypertrophied muscularis propria, nerve plexus, and ganglion cells located within the circular layer rather than the normal myenteric location , for the first time in the English literature.

Cell edge detection in JPEG wavelet domain - analysis on sigmoid function edge model. Big virtual microscopy images 80K x 60K pixels and larger are usually stored using the JPEG image compression scheme. Diagnostic quantification, based on image analysis, might be faster if performed on compressed data approx. The analysis of possible edge detection without reverse wavelet transform is presented in the paper. Two edge detection methods, suitable for JPEG bi-orthogonal wavelets, are proposed. The methods are adjusted according calculated parameters of sigmoid edge model.

The results of model analysis indicate more suitable method for given bi-orthogonal wavelet. Ischemic or toxic injury: A challenging diagnosis and treatment of drug-induced stenosis of the sigmoid colon. A year-old woman was admitted with mo history of abdominal pain, diarrhea and hematochezia, and 5-mo history of defecation difficulty. She had been successively admitted to nine hospitals, with an initial diagnosis of inflammatory bowel disease with stenotic sigmoid colon.

Findings from computed tomography virtual colonoscopy, radiography with meglumine diatrizoate, endoscopic balloon dilatation, metallic stent implantation and later overall colonoscopy, coupled with the newfound knowledge of compound Qingdai pill-taking, led to a subsequent diagnosis of ischemic or toxic bowel disease with sigmoid colon stenosis. The patient was successfully treated by laparoscopic sigmoid colectomy, and postoperative pathological examination revealed ischemic or toxic injury of the sigmoid colon, providing a final diagnosis of drug-induced sigmoid colon stenosis.

This case highlights that adequate awareness of drug-induced colon stenosis has a decisive role in avoiding misdiagnosis and mistreatment. The diagnostic and therapeutic experiences learnt from this case suggest that endoscopic balloon expansion and colonic metallic stent implantation as bridge treatments were demonstrated as crucial for the differential diagnosis of benign colonic stenosis.

Skillful surgical technique and appropriate perioperative management helped to ensure the safety of our patient in subsequent surgery after long-term use of glucocorticoids. Sigmoid function based integral-derivative observer and application to autopilot design. To handle problems of accurate signal reconstruction and controller implementation with integral and derivative components in the presence of noisy measurement, motivated by the design principle of sigmoid function based tracking differentiator and nonlinear continuous integral-derivative observer, a novel integral-derivative observer SIDO using sigmoid function is developed.

The key merit of the proposed SIDO is that it can simultaneously provide continuous integral and differential estimates with almost no drift phenomena and chattering effect, as well as acceptable noise-tolerance performance from output measurement, and the stability is established based on exponential stability and singular perturbation theory. In addition, the effectiveness of SIDO in suppressing drift phenomena and high frequency noises is firstly revealed using describing function and confirmed through simulation comparisons.

Finally, the theoretical results on SIDO are demonstrated with application to autopilot design: Among all types of cancer, gynecological malignancies belong to the 4th most frequent type of cancer among women. Besides chemotherapy and external beam radiation, brachytherapy is the standard procedure for the treatment of these malignancies. In the progress of treatment planning, localization of the tumor as the target volume and adjacent organs of risks by segmentation is crucial to accomplish an optimal radiation distribution to the tumor while simultaneously preserving healthy tissue. Segmentation is performed manually and represents a time-consuming task in clinical daily routine.

The proposed segmentation method uses an interactive, graph-based segmentation scheme with a user-defined template. The scheme creates a directed two dimensional graph, followed by the minimal cost closed set computation on the graph, resulting in an outlining of the rectum. The graphs outline is dynamically adapted to the last calculated cut. The comparison of the algorithmic to manual results yielded to a Dice Similarity Coefficient value of Utilizing the proposed methodology resulted in a median time of seconds per dataset, compared to seconds needed for pure manual segmentation.

Postoperative bacteriuria, pyuria and urinary tract infection in patients with an orthotopic sigmoid colon neobladder replacement. The purpose of this study is to investigate the prevalence of postoperative bacteriuria, pyuria and urine culture in patients with an orthotopic sigmoid colon neobladder replacement. Urine samples for bacteriuria, pyuria and urine culture, if necessary, were collected at 1, 3, 6, 9 and 12 months after surgery and the presence of blood culture and antibiotic-resistant strains, and their treatments on positive urine culture cases were investigated. Of for bacteriuria and for pyuria urine samples with evaluable data, 95 Totally, 30 bacteria were isolated from urine culture of urinary tract infection UTI and Klebisiella pneumoniae, Escherichia coli, Staphylococcos aureus and Enterococcus spp.

In them, there were six bacteria In conclusion, these findings suggest that physicians taking care of sigmoid colon neobladder patients need to be aware of these high ratios of bacteriuria, pyuria and UTI, including bacteremia. A year-old woman complaining of fetor ex vagina was diagnosed with endometrial adenocarcinoma of the uterus based on the pathological findings of an endometrial biopsy.

Sigmoid colon cancer was found on a pre-operative CT scan. Diagnosis of double cancer was made and we performed sigmoidectomy and panhysterectomy with associated resection of both adnexa. Histopathological examination found that the tumor accounted for almost all of the uterine mucosa and over half of the muscular layer. The pathological diagnosis was a moderately differentiated adenocarcinoma, pT4b SI: Although colorectal cancer rarely metastasizes to the uterus, due to the increase in the prevalence of colorectal cancer, it may be also increase.

To choose the best treatment course, it is necessary to diagnose whether it is a primary uterine cancer or a metastatic uterine cancer. When fecal impaction is the underlying cause, the condition is usually managed conservatively, but may on occasion become complicated and even require surgical intervention. A 58 years old woman arrived at the Emergency Room ER with persistent constipation for the last six days. An abdominal CT scan showed a large fecal mass at the sigmoid colon with retrograde dilated colonic loops.

After a few minutes we started to fragment the fecalith, the consistency of which had been notably decreased. We report on three-dimensional MHD simulations of recurrent mini coronal mass ejection CME -like eruptions in a small active region AR , which is formed by the dynamical emergence of a twisted not kink unstable flux tube from the solar interior. The eruptions develop as a result of the repeated formation and expulsion of new flux ropes due to continuous emergence and reconnection of sheared field lines along the polarity inversion line of the AR.

The acceleration of the eruptions is triggered by tether-cutting reconnection at the current sheet underneath the erupting field. Modelling of electric characteristics of watt peak solar panel using Boltzmann sigmoid function under various temperature and irradiance. Solar energy utilized with solar panel is a renewable energy that needs to be studied further. The site nearest to the equator, it is not surprising, receives the highest solar energy.

In this paper, a modelling of electrical characteristics of Watt peak solar panels using Boltzmann sigmoid function under various temperature and irradiance is reported. Current, voltage, temperature and irradiance data in Denpasar, a city located at just south of equator, was collected. Solar power meter is used to measure irradiance level, meanwhile digital thermometer is used to measure temperature of front and back panels. Short circuit current and open circuit voltage data was also collected at different temperature and irradiance level. Statistically, the electrical characteristics of Watt peak solar panel can be modelled using Boltzmann sigmoid function with good fit.

Therefore, it can be concluded that Boltzmann sigmoid function might be used to determine current and voltage characteristics of Watt peak solar panel under various temperature and irradiance. The cost effectiveness of elective laparoscopic sigmoid resection for symptomatic diverticular disease: Direct healthcare costs of patients with symptomatic diverticular disease randomized for either laparoscopic or open elective sigmoid resection are compared.

Cost-effectiveness analysis of the laparoscopic approach compared with open sigmoid resections is presented. An economic evaluation of the randomized control Sigma trial was conducted, comparing elective laparoscopic sigmoid resection LSR to open sigmoid resection OSR in patients with symptomatic diverticulitis. Prospective registration of detailed intervention units per patient resulted in actual resource use per individual patient.

To avoid distributional assumptions, the nonparametric bootstrap was applied. Previously, I argued that there is a synchronic as well as a diachronic dimension to the way our controversy has unfolded. Whereas the latter points to some general developments, the former might 73 On Van Heugten, cf. Van der Marel and Van Keulen ; on Sierksma, cf. For the sake of analysis, different periods will be identified, more or less corresponding to the years in which certain important contributions to the controversy were published.

The first period began with the first reviews in and lasted till Apart from the date on which certain important essays and studies appeared in print, other criteria determined the way in which I distinguished between different periods as well, i. Yet, even then, we must look at the contributions in more detail.

In chapter II, I will employ methods derived from linguistics in order to identify the distinguishing feature of polemical texts and to figure out which contributions can be classified into this category. Terminology will be derived from poetical analy- sis as it has been inspired by psychoanalysis Even though mainly applied to literary texts, I agree with Hayden V. White that the mechanisms underlying these artifacts are equally relevant for the study of other textual material.

White himself has em- ployed them for his analysis of historical narrative and cultural criticism. Sig- nificant for polemics, however, is the fact that it substitutes or displaces the argument for its author. Instead of taking the text as its main object of attack, in polemic a subject is created in order to account for the contradiction between the opinions defended in the text and the ones held by the critic.

And rather than countering the argument, it is rendered invalid simply by derogating the author imagined behind the text. This is done by questioning the moral, mental or professional capacity of the subject accountable for the argument. As will be shown, the mechanism, previously defined as paranoia, is similar to that identified by Freud in his study on wit-work. Terminology will be derived especially from the work of Robert Hariman on political style. And even though texts are not to be confused with political reality, in both cases there is always an element of pretense.

As in the case of paranoid personality disorder, with its arro- gance and compensatory grandiose delusion, styles are employed in order to create a sense of authority, rather than to reflect some actual state of affairs. Hariman identifies four different political styles, namely realist, republican, bureaucratic and authoritarian ones.

With the help of others I will attempt to translate these styles of conduct into ways of arguing as exemplified in texts. This fits with the way arguments are substituted by their author. Rather than attempting to convince the public by being realistic, moderate and referenced, critics tend to mere- ly declare the author unfit, and by that, the argument is declared invalid. For that they do not need any support; their personal judgment must be sufficient to remove the contradiction between the arguments developed in the text and those held by the critic involved.

The interesting question to be answered is whether the personal and authoritarian style is tied to the personal authority of which Bourdieu wrote. In order to come to a conclusion about that, we cannot limit ourselves to textual analysis only. In chapter IV, I will apply the method of sociological analysis.

By this I mean to identify both the institutional network in which intellectuals participate and their relationship with the public. Rather than employing the so-called secularization thesis to account for the trends in the history of the reception of De toekomst der religie—as other students of polemics have done—, I intend to focus on the position of each individual within the field of cultural production.

Of particular interest here is the sociology of Bourdieu78, as well as the sociological direction within the discourse analysis stimulated by Michel Foucault and further developed by Norman Fair- clough. Instead of assu- ming that texts do not have any link with the outside world, I agree with Bourdieu that the ideologies developed in polemic are always doubly determined.

More speci- 76 Hariman Applied to the context of the Netherlands from till , some intellectuals might have been dominant within their own local community, without having had much influ- ence in wider society. Significant developments within the country did not prevent people from staying within tightly structured pillar organizations. Also, however, for those intellectuals, their relations with the public will be considered of the utmost importance in understanding their contributions to the controversy which we are studying. The centerpiece of this moral configuration is an uneven balance of power and the tension inherent within it.

I shall now devote what remains of my introduction to confronting criticism by those who find my hypothesis unfit because it includes some value judgments. These critics might even doubt whether my claims are any different form the methods employed in polemic and, consequently, conclude that they are not scientific at all. First of all, does the fact that I interpret some contributions to the controversy as polemical include a value judgment on my part?

Critics are correct in believing detai- led arguments not to be value free for the mere fact that they are detailed. There is 80 Bourdieu , , Elias And the latter are selected according to the limits set by the questions for which both description and analysis are meant to provide an answer. In concert with the postmodern authorities which I have invoked throughout my study, I believe that even the ego of scientists always plays an important role in the enterpri- se. Yet, I definitely do not believe that science is to be reduced to any kind of perso- nal aberration on the part of the scholars involved.

If that would be implied by post- modernism, I definitely do not agree. I do not believe that there is no qualitative difference between the personal judgments we found in polemics on the one hand and my judgment that in polemics, arguments are distorted and people launch attacks against others that cannot be justified by means of facts about the other. This statement by Vestdijk surely included a personal judg- ment. He did not deny this. The point is that he tried to offer reasons for why he wished Christianity to die. Yet, his opponents did not let themselves be deceived by that.

According to them, nobody could reasonably argue such a claim. Moreover, Vestdijk was a novelist rather than a theologian or scholar of religion. Instead of taking his argument seriously, they attempted to suggest that he was either mentally or morally disturbed. To be sure, somebody arguing that he, personally, wishes Christianity to die might be insane. The point, however, is whether this is a fact or mere speculative inference. Without serious discussion of the symptoms that are usually linked to mental disorders, we might be incorrect in judging people that are, in reality, quite sanguine and sane.

Popper did not consider science to be completely different from other opinions expressed within the public sphere either and polemical exchange has to be inclu- ded, as well. On the contrary, he agreed with Russell that science begins with in- stinct and intuition as much as any other cognitive enterprises.

The fundamental difference between scientific claims on the one hand, and other statements on the other, is that the former can be rationally tested and, in the end, either confirmed or refuted. Certainly, I make claims about the personal situation of my objects as much as these did of Vestdijk and his opponents. Yet, instead of being mere speculation, I 82 Popper , , ; cf. In a way, this came as no surprise, as even before the war Vestdijk had been the acknowledged primus inter pares of Dutch literature.

Though others would soon join him, after the death of Menno ter Braak, Edgar du Perron and Hendrik Marsman, Vestdijk was the only one left of a pre-war generation of leading literary critics. He concluded that it was extremely difficult to situate him between the extremes of good and evil.

At all times, Vestdijk had written and published in what Venema called the twilight zone of pro- test, adaptation, and adjustment, or even collaboration. According to Sierksma, by giving the Germans the idea that he did not pose any threat to their authority, Vestdijk had just been trying to save his neck. The only thing that had changed was the way in which critics judged public figures that did not participate in the resistance. As Regine Grueter observed in her discussion of the Weinreb-affair, it was only from the s onwards that criteria of good and evil were more systematically applied to persons playing a public role dur- 1 October 28, According to her, this was typical of a period in which public sentiment turned against a pre-war-yet-still-powerful establishment.

On the contrary, people remembered him as one of the intellectuals taken hostage by the enemy. For the broad public he was the only fa- mous Dutch writer remaining from the prewar period. Nobody asked why he had been released by the Germans so early in the war, while others would have to remain imprisoned until the very end. His fellow hostages may have been jealous, as Vestdijk himself observed,7 but they were not aware of the reasons for which the Germans let him go. In this post-war atmosphere, the publication of De toekomst der religie was an- nounced by the Zondagspost, though it was actually published two years later.

The publisher was well known for its publications in the field of psychology.

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Clearly, Vestdijk had written a study on religion from a psychological and humanist perspec- tive. In fact, people from a wide variety of intellectual circles felt challenged. Vestdijk expected a reaction to his arguments. The essay consisted of a series of lectures that were originally meant to be delivered before his fellow hostages in Beekvliet.

Yet, even though an earlier series of lectures was received enthusiastically, the one on religion did not receive much attention. Only the first lecture was deliv- ered, and with only one person in attendance, the lecture series was discontinued. I got 5 Grueter I will have to proceed cautiously in these mat- ters. However, to understand why it triggered the intense debate it did is something quite different.

But, as soon as the essay became available to a wider public, this approach would not do anymore. We are dealing here with quite a lengthy essay, numbering pages. And for many critics, for many different reasons, it was not easy to swallow. Nevertheless, it triggered many responses , from many people almost , over a considerable period of time 50 years.

Certainly, attention waned over time. Every time the essay was re-edited, it received some response. However, at the end of the 20th century, interest had died out almost completely. And, with the exception of one critic, nobody paid much attention to his essay on religion anymore.

No attention will be paid to the essay itself. Though it was published shortly after the war, in a sense, the job was not finished yet. On the con- trary, whereas the writing process had initially been hidden from the eyes of the outside public, the real work in fact began immediately after the public started read- ing the end product and tried to make sense of it.

From a synchronic point of view, each period consisted of polemical as well as non- polemical contributions. From a diachronic point of view, we will see the polemics becoming increasingly marginal. Only in the last chapter will an explanation be given for why some critics reacted in a polemical manner, and why their influence receded in the course of the controversy. The periods of the reception In the present chapter, I wish to focus on the chronological sequence on the one hand, and the interconnections between contributions on the other.

The first will be done in order to indicate developments, the latter to identify some specific traditions within the history of reception. With respect to the developments, different periods can be distinguished. For this, I propose to use the following three criteria. Each period has a specific ratio of contributions that are to be considered as polemical. Which contributions count as polemical will be discussed in the next two chapters; here we shall simply make distinctions in a preliminary fashion. Secondly, the institu- tional context is important, for it indicates the radius of both the essay and each con- tribution to the history of its reception.

As we will see, in the early periods, it is easy to define groups of intellectuals according to their institutional memberships and contributions to the media. As in the case of the intensity of the exchanges, we shall deal here with these contexts only in a preliminary fashion; in the last chapter, I will offer a detailed discussion of the issue. Thirdly, in accordance with the dynamics in any history of reception, the changing role of the text itself will be an important feature of each period.

In general, it developed from being the main focus of almost every single review, to increasingly becoming part of a discussion either of single issues or of other writings. As such, it participates in a continuous process of produc- tion and progress of reflection, in which it gradually shifted into the margins of public attention.

These three criteria are more diverse and specific than the ones employed by Monique Despret, on whom I have commented extensively in the introduction. Whereas she only distinguished between two periods the first from till , the second from till , I shall distinguish between four. This essay also marked an era in which almost all contributions exclusively focused on both Vestdijk and De toekomst der religie. This period was the most intensely polemical.

By far the most contributions were written during this time. The diversity of people responding, as well as the role of the media, were more intense than in later periods. On the other hand, it is quite easy to identify several distinctive traditions of criticism, partly made up by pillar organizations, and partly by independent magazines. This also holds true for the next period.

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The latter focused on both Vestdijk and the polemics around De toekomst der religie. On the one hand, this triggered new polemics. On the other hand, however, Vestdijk was forced to share attention with Sierksma. Far less people responded, and, in general, the media—newspapers and opinion magazines—were less interested in publishing the issue for a wider public. The third period from till continued the tendencies started earlier. De toekomst der religie was often mentioned, but played only a marginal role.

However, the publication of a third and fourth edition of the essay showed that there were still people interested in the topic which Vestdijk had dealt with. For most commentators, Vestdijk seemed a part of history, and even an expression of the modern mentality in general. Traditions of criticism in this period were less easily identified than before, primarily through ecu- menical tendencies in formerly well-established institutions. Not surprisingly, the end of the period was marked by a theological critique by theologians from highly diverse backgrounds.

The publication of the fifth edition of the essay was only briefly mentioned in the media; discussion was limited to highly esoteric circles of Vestdijk fans. The publication of the last edition of the essay did not receive any atten- tion at all. The edition ended up in discount bookstores. By the end of the cen- tury, only Kamphuis felt challenged by the arguments formulated in De toekomst der religie.

First, I wish to discuss each period of reception more specifically and to identify the writings on the essay by means of their authors and the media involved. Secondly, I will attempt to draw some conclu- sions with respect to the developments and traditions within the reception and the appropriation of the essay. Period 1 — After the war, religious differences still dominated public life.

It is the institutional aspect of these differences that will be employed in order to classify the contributions to our polemic. Church membership, university positions end media activities will be considered as the most distinguishing features. As was previously mentioned, during this period it is quite easy to classify the people who participated in the controversy. Many of them belonged to tightly knit organized institutions; others contributed to media forms that held a more or less independent position within the public sphere in the Netherlands.

Next, I shall attempt to present the intellectuals who con- tributed to the polemic during the first period of the reception. Reactions from the intellectuals of the VGKN, an orthodox group which contin- ues with its critiques to this very day, came early on. It is, however, unlikely that these were the theologians to which Vestdijk had referred in his letters to Theun de Vries. Dominated by the dogmatist K. Schilder,12 this group had separated from the GKN in Though well known for his polemical style of arguing, Schilder did not play any role in the controversy around Vestdijk.

Though generally critical, some members of the GKN reacted to Vestdijk quite positively. Berkouwer, the dogmatist of the Vrije Universiteit, devoted one of his weekly commentaries in Trouw on De toekomst der religie. Something similar held true for the commentary of J. Bavink, the prominent missionary theologian of the GKN. Popma, made some positive remarks as well. Wapenaar in Trouw18 as well as J. Teeuwen in the Reformed opinion monthly Horizon. The only polemical contribution during this period 12 Cf. Akkerman ; on De Reformatie cf. Harinck ; on Ontmoeting cf. Van Keulen ; on Trouw cf.

Van der Ros a, Bak Banning made only a passing critical remark regarding Vestdijk,27 but the review of the Groningen philosopher H. Vest- dijk himself wrote a counter-critique,31 which was not accepted by Het Parool. De Vos did not answer Vestdijk. The same thing happened after the highly polemical contributions by G. Miskotte, a famous dogmatist at Leiden who wrote for Vrij Nederland. Berkhof , the first to define this modality within the Netherlands Reformed Church as something between liberal and orthodox denominations, while being more orthodox than liberal.

Ponsteen ; on Het Parool cf. Waardenburg ; on Wending cf. Braams , Berkelaar Bomhoff in Wending would be made only later, in what I call the second period of the contro- versy. Even though her contribution was also polemical, a kind of dialogue took place between the Mennonite reverend A. She wrote a critique in De Groene Amsterdammer, to which Vestdijk responded in the literary criti- cal magazine Criterium. She again responded, but Vestdijk was allowed the last word. Bleeker in a liberal theological magazine were tasteful. Vestdijk wrote a response, though Bleeker did not react to it.

He was a theologian and a member of the NHK, to be sure. But so were others, to which Vestdijk and, later on, Sierksma did not react. Berkelbach van der Sprenkel, who wrote a moder- ate yet critical review in a newspaper. Ros- cam Abbing, which appeared in a theological magazine.

Sterkman, invited by P. Later, his remarks were published in a book maga- zine.

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Critical, but far more respectful, than the theologians were the intellectuals with esoteric liberal and literary critical orientations. Some of them belonged to the the- osophist circle. They used to operate independently from every other religious group. After that, in the same magazine, D. Vestdijk responded, though Poortman was allowed the last word on the subject. Redeker within the context of an essay on existentialist philosophy.

On several occasions the latter invited him to join their circle. Among them was O. Noordenbos, who wrote a positive review of De toekomst der religie in a moderately socialist opinion monthly, De Nieuwe Stem. Barneveld, was also positive about Vestdijk. Van den Burg For this criti- cism he was attacked by Sierksma, the main editor of the literary and opinion monthly, Podium.

He also accused Vestdijk, who had also been one of the Forum-editors, of betraying his own past. Sicking , Calis Dijkstra , on Kroniek voor Kunst en Kultuur cf. Secondly, he himself attacked Barneveld. To this critique, Vestdijk responded. The first period, however, would be by far the most polemical. Minor intellectuals, politically progres- sive theologians from the NHK, the Mennonite community as well as literary critics were among the most aggressive opponents.

Vestdijk himself launched counter- attacks against some of these opponents. Apart from Sierksma, Noordenbos and Barneveld would join him. The controversy was played out in newspapers, opinion monthlies and literary magazines. Both the intensity of the polemic and the range of public that it reached differed considerably from later periods.

Critiques of theologians had been written for Het Parool, Vrij Nederland, and Wending, but the editors had not allowed them to be published. And though Sierksma offered Vestdijk the opportunity to let them appear in Podium, the 66 On Sierksma cf. Philosopher and literary critic J. A friend of Vestdijk and Sierksma, A. Marja pseudonym for J. He concluded that writers become especially well-known when they have a bad reputation.

Other contributions mainly focused on Tussen twee vuren, without even mention- ing the reprint of De toekomst der religie. Noordenbos wrote a review for De Nieuwe Stem. Within this context they referred to a review of Tussen twee vuren by J. And here we meet 72 Cf. Hazeu , Van Delden Hofstee , Hak A clear example of the trend towards dialogue is observable in the contributions by H. In the latter monthly, he initiated something which, according to him, was meant as a serious attempt at dialogue with both Vest- dijk and Sierksma.

He admitted that the polemical style previously employed by theologians was not justifiable. Instead, he attempted to initiate an extensive discus- sion of some of the most relevant topics. At the same time, he aligned himself with the attacks on De religieuze projectie previously launched by Mennonite J. Ooster- baan and humanist Kwee Swan Liat. Yet, Vestdijk did not feel forced to engage in the type of dialogue which Kraemer pursued. In fact, it was Sierksma who responded, without, however, expecting too much to come out of the discussion.

Kraemer offered a counter- critique, while the editors of Wending allowed Sierksma to close the discussion. Liberal theologians of the NHK distanced themselves from the type of dialogue initiated by Kraemer in Wending. Certainly, Vestdijk and Sierksma had to be taken seriously, as Remonstrant J. Faber previously argued in opinion and church magazines. Theologians had to justify their stance not only towards or- thodox tendencies, but also to the outside world. Witteveen , on Faber cf.

One of the fiercest and most influential critics was J. Touw made some polemical remarks. Though Vest- dijk did not figure in the rest of this polemic, indirectly he contributed to the case as a means by which liberals and middle orthodox defined their boundaries. And, as we will see, Smits would on several occasions express his sympathy for Vestdijk, as well as for Sierksma. The exchanges and increasing interaction between Mennonite and NHK theolo- gians and their opponents were not the only contributions to the controversy.

GKN- theologians contributed as well. Berkouwer offered a review of both the reprints of De toekomst der religie and Tussen twee vuren. Berkouwer, for example, did not spare theologians for their personal attacks without accusing Vestdijk and Sierksma of the same weak- nesses. He warned his own brothers about committing the same mistakes.

This be- comes especially clear in his review of collected polemical essays by Vestdijk,90 as well as in his comments on the literary exchange between Sierksma and Kraemer. He published an essay in Bezinning in which he offered an extensive review of De religieuze projectie. He also used this opportunity to criticize both De toekomst der religie and Tussen twee vuren. For this he made positive reference to early comments on psychological approaches to religion and religious projection by Berkouwer and Bavinck.

His ap- proach was also much more sympathetic and moderate than that of minor GKN 87 Buskes , Touw ; on Buskes cf. De Jong , on Touw cf. Oorsprong en kennis der zonde Pos, who attacked Vestdijk for his arguments against Christianity in Horizon. Hekstra emphasized the superiority of both over their opponents, particularly Miskotte.

Zijlstra , for his per- sonal attack. According to them, a discussion could be useful to illuminate themes and characters figuring in his novels. Though they greatly appreciated his artistic qualities, he was constantly criticized for the moral confusion thought to be characteristic of his novels. According to these critics, there was an immediate link between this confusion and his atheism. This ambivalence was clear in the contributions by Bomhoff. Beljon appreciated his work in much the same way. Catholics like Josine Meyer and Th. Govaart were more moderate, thus more resembling Popma himself.

In general, however, interaction between intellectuals of different traditions was increasing. Apart from them, two other groups of intellectuals were equally critical of both these theologians and their critics, notably Vestdijk and Sierksma. On the one hand, a clash arose between middle-orthodox and more liberal theologians within the NHK. Kraemer, Buskes and Smits played a leading role within this context. The contribution of Kraemer offered a genuine attempt to follow this strategy. A period of reflection had begun. The only exceptions were some minor intellectuals of the GKN, who still seemed to be isolated from other critical traditions.

Given these trends, it is not surprising that essays, rather than reviews, prevailed in this period. These essays were mainly written for opinion monthlies or published as a chapter or part of a book, rather than as articles in newspapers. In general, contributions were limited to certain intellectual circles. However, though there was less diversity among the critics, reactions became more serious and thorough.

This also meant that the public aimed at was more limited, especially with Cf. This tendency would become even more pronounced in the third period. Period 3 — As we observed during the previous period of the controversy, contributions no longer focused exclusively on De toekomst der religie. This trend continued into the period which we shall now discuss. To this Vestdijk responded, arguing that Van Stempvoort was mis- taken on some matters of fact and, as a man of science, should be more careful.

Even though it initiated some new attention for De toekomst der religie, critiques of its third edition also triggered the very last reply which Vestdijk would make to his oppo- nents. After that, neither Vestdijk nor Sierksma would contribute to the controversy anymore. Van Stempvoort wrote a counter-critique, in which he avoided the points made by Vestdijk, and focused, instead, on the role played by Western intellectuals in general. Yet, as previously indicated, Vestdijk had written his final contribution to the controversy, and would not respond to Van Stempvoort anymore.

Verhoeven, was highly polemical in his com- ments on the essay. Noordenbos wrote an extensive and positive review in De Nieuwe Szczesny ; translation of Szczesny, Die Zukunft des Unglaubens ; cf. Jager , Struyker Boudier a: Sperna Weiland in Wending, were highly critical of the arguments offered by both Szczesny and Vestdijk. Nevertheless, their style of arguing was moderate and they did not use any personal invectives.

It was still possible to distinguish between different critical traditions. On the other hand, intellectuals from the RKK drew wide attention with their highly sophisticated critiques of Vestdijk and Sierksma. Nijk, explained, the volume was intended to offer a serious theological reflection on the problems raised by Vestdijk and especially Sierksma. The issue started with two articles written by two experts in their fields. Plokker dealt with the psychology of projection, while the chemist C. Dippel focused on the problem of observation in the natural sciences.

The first, written by A. Dumas, dealt with the relevance of the concept of projection as developed in the Marxist tradition. The other, written by L. The contributions by J. Van Leeuwen, and C. The article by Nijk, a liberal protestant theologian, triggered some critical comments from C. Dippel, one of the foremost middle-orthodox intellectuals of Dutch Protestantism. After reading the con- tributions, it seemed more difficult than ever to find a common ground between scientists and theologians. While the first clearly did not take God into account, the latter continued to include God in their reflections, arguing that scientific theory was Noordenbos Van Dijk , Van Berkelaar The problem, however, became even more com- plicated since believers did not agree on the means by which the existence of God could be known.

Heering thus referred to a problem that had been pressing since the rise of liberal Protestantism. Important in this case, however, was the fact that a dis- cussion arose regarding theories offered by acknowledged unbelievers. And it seemed as though the editors did not truly believe in a dialogue between unbelievers and theologians. Unlike Kraemer, they invited neither Vestdijk nor Sierksma for a counter-critique. Serious and extensive discussion and criticism was initiated by progressive intel- lectuals within Roman Catholic circles. Background Research evidence is not always being disseminated to healthcare providers who need it to inform their clinical practice.

This can result in the provision of ineffective services and an inefficient use of resources, the implications of which might be felt particularly acutely in low- and middle-income countries. Methods This study compares what is known about ITNs to the related knowledge and practices of healthcare providers in four low- and middle-income countries. A new questionnaire was developed, pilot tested, translated and administered to healthcare providers in Ghana , Laos , Senegal and Tanzania Ten questions tested participants' knowledge and clinical practice related to malaria prevention.

Additional questions addressed their individual characteristics, working context and research-related activities. Ordinal logistic regressions with knowledge and practices as the dependent variable were conducted in addition to descriptive statistics. Statistically significant factors associated with higher knowledge within each country included: Statistically significant factors associated with better clinical practices within each country include: Determinants of community health fund membership in Tanzania: In many developing countries, initiatives are underway to strengthen voluntary community based health insurance as a means of expanding access to affordable care among the informal sector.

However, increasing coverage with voluntary health insurance in low income settings can prove challenging. There are limited studies on determinants of enrolling in these schemes using mixed methods. This study aims to shed light on the characteristics of those joining a community health fund, a type of community based health insurance, in Tanzania and the reasons for their membership and subsequent drop out using mixed methods. A cross sectional survey of households in four rural districts was conducted in , covering a total of 1, members of CHF and non-insured households and 7, individuals.

In addition, 12 focus group discussions were carried out with CHF members, non-scheme members and members of health facility governing committees in two rural districts. Logistic regression was used to assess the determinants of CHF membership while thematic analysis was done to analyse qualitative data. The quantitative analysis revealed that the three middle income quintiles were more likely to enrol in the CHF than the poorest and the richest.

CHF member households were more likely to be large, and headed by a male than uninsured households from the same areas. The qualitative data supported the finding that the poor rather than the poorest were more likely to join as were large families and of greater risk of illness, with disabilities or persons with chronic diseases. Households with elderly members or children under-five years were also more likely to enrol. Poor understanding of risk pooling deterred people from joining the scheme and was the main reason for not renewing membership.

On the supply side, poor quality of public care services, the limited benefit package and a lack of provider choice were the main factors for low enrolment. Maternal and newborn healthcare providers in rural Tanzania: Major improvements in maternal and neonatal health MNH remain elusive in Tanzania. The causes are closely related to the health system and overall human resource policy.

Staff motivation is also a challenge. In rural areas the problems of recruiting and retaining health staff are most pronounced. Yet, it is here that the majority of the population continues to reside. A detailed understanding of the influences on the motivation, performance and job satisfaction of providers at rural, primary level facilities was sought to inform a research project in its early stages.

The providers approached were those found to be delivering MNH care on the ground, and thus include auxiliary staff. Much of the previous work on motivation has focused on defined professional groups such as physicians and nurses. While attention has recently broadened to also include mid-level providers , the views of auxiliary health workers have seldom been explored.

In-depth interviews were the methodology of choice. An interview guideline was prepared with the involvement of Tanzanian psychologists, sociologists and health professionals to ensure the instrument was rooted in the socio-cultural setting of its application. Interviews were conducted with 25 MNH providers , 8 facility and district managers, and 2 policy-makers.

Key sources of encouragement for all the types of respondents included community appreciation, perceived government and development partner support for MNH, and on-the-job learning. Discouragements were overwhelmingly financial in nature, but also included facility understaffing and the resulting workload, malfunction of the promotion system as well as health and safety, and security issues.

Low-level cadres were found to be particularly discouraged. Difficulties and weaknesses in the management of rural facilities were revealed. Improvements in access to malaria treatment in Tanzania after switch to artemisinin combination therapy and the introduction of accredited drug dispensing outlets - a provider perspective.

Background To improve access to treatment in the private retail sector a new class of outlets known as accredited drug dispensing outlets ADDO was created in Tanzania. Tanzania changed its first-line treatment for malaria from sulphadoxine-pyrimethamine SP to artemether-lumefantrine ALu in The effect of these interventions on access to malaria treatment was studied in rural Tanzania.

Data collection consisted of: The data were complemented with DSS population data. Particular improvements were observed in the availability from 0. In-season monitoring of crop conditions provides critical information for agricultural policy and decision making and most importantly for food security planning and management. Nationwide agricultural monitoring in countries dominated by smallholder farming systems, generally relies on extensive networks of field data collectors. In Tanzania , extension agents make up this network and report on conditions across the country, approaching a "near-census".

Data is collected on paper which is resource and time intensive, as well as prone to errors. Data quality is ambiguous and there is a general lack of clear and functional feedback loops between farmers, extension agents, analysts and decision makers. Moreover, the data are not spatially explicit, limiting the usefulness for analysis and quality of policy outcomes. Despite significant advances in remote sensing and information communication technologies ICT for monitoring agriculture, the full potential of these new tools is yet to be realized in Tanzania. Their use is constrained by the lack of resources, skills and infrastructure to access and process these data.

The use of ICT technologies for data collection, processing and analysis is equally limited. These tools are developed and applied in Tanzania through the National Food Security Division of the Ministry of Agriculture, Food Security and Cooperatives MAFC within a statistically representative sampling framework area frame that ensures data quality, representability and resource efficiency.

Method for providing a compliant cantilevered micromold. A compliant cantilevered three-dimensional micromold is provided. The compliant cantilevered micromold is suitable for use in the replication of cantilevered microparts and greatly simplifies the replication of such cantilevered parts. The compliant cantilevered micromold may be used to fabricate microparts using casting or electroforming techniques. When the compliant micromold is used to fabricate electroformed cantilevered parts, the micromold will also comprise an electrically conducting base formed by a porous metal substrate that is embedded within the compliant cantilevered micromold.

Methods for fabricating the compliant cantilevered micromold as well as methods of replicating cantilevered microparts using the compliant cantilevered micromold are also provided. Narratives of Nurse-Midwives and Obstetricians. Postpartum education can save lives of mothers and babies in developing countries, and the World Health Organization recommends all mothers receive three postpartum consultations. More information is needed to better understand how postpartum education is delivered and ultimately improves postpartum health outcomes. The purpose of this qualitative study was to examine how postpartum care was delivered in three postnatal hospital clinics in Dar es Salaam, Tanzania.

Semistructured interviews with 10 nurse-midwives and three obstetricians were conducted. Feminist poststructuralism guided the research process. Postpartum education was seen to be an urgent matter; there was a lack of supportive resources and infrastructure in the hospital clinics, and nurse-midwives and obstetricians had to negotiate conflicting health and traditional discourses using various strategies.

Nurse-midwives and obstetricians are well positioned to deliver life-saving postpartum education; however, improvements are required including increased number of nurse-midwives and obstetricians. Job satisfaction and turnover intentions among health care staff providing services for prevention of mother-to-child transmission of HIV in Dar es Salaam, Tanzania.

From March to April , a questionnaire asking about job satisfaction and turnover intentions was administered to all nurses at 36 public-sector health facilities offering antenatal and PMTCT services in Dar es Salaam, Tanzania. Multivariable logistic regression models were used to identify factors associated with job dissatisfaction and intention to quit one's job. Most of the providers were dissatisfied with low salaries and high workload, but satisfied with workplace harmony and being able to follow their moral values.

The odds of reporting to be globally dissatisfied with one's job were high if the provider was dissatisfied with salary adjusted odds ratio aOR 5. The following factors were associated with providers ' intention to leave their current job: Job dissatisfaction and turnover intentions are comparatively high among nurses in Dar es Salaam's public-sector maternal care. If malaria patients who cannot be treated orally are several hours from facilities for injections, rectal artesunate prior to hospital referral can prevent death and disability.

The goal is to reduce death from malaria by having rectal artesunate treatment available and used. How best to do this remains unknown. Villages remote from a health facility were randomized to different community-based treatment providers trained to provide rectal artesunate in Ghana, Guinea-Bissau, Tanzania , and Uganda.

Prereferral rectal artesunate treatment was provided in villages: Differences in treatment coverage with rectal artesunate in children aged Effectiveness of artemether-lumefantrine provided by community health workers in under-five children with uncomplicated malaria in rural Tanzania: Home-management of malaria HMM strategy improves early access of anti-malarial medicines to high-risk groups in remote areas of sub-Saharan Africa.

However, limited data are available on the effectiveness of using artemisinin-based combination therapy ACT within the HMM strategy. The aim of this study was to assess the effectiveness of artemether-lumefantrine AL , presently the most favoured ACT in Africa, in under-five children with uncomplicated Plasmodium falciparum malaria in Tanzania , when provided by community health workers CHWs and administered unsupervised by parents or guardians at home.

An open label, single arm prospective study was conducted in two rural villages with high malaria transmission in Kibaha District, Tanzania. Children presenting to CHWs with uncomplicated fever and a positive rapid malaria diagnostic test RDT were provisionally enrolled and provided AL for unsupervised treatment at home. Patients with microscopy confirmed P. Primary outcome measure was PCR corrected parasitological cure rate by day 42, as estimated by Kaplan-Meier survival analysis.

This trial is registered with ClinicalTrials. A total of febrile children were enrolled between March-August Two patients were lost to follow up on day 14, and one patient withdrew consent on day The PCR corrected cure rate by day 42 was Provision of AL by CHWs for unsupervised malaria treatment at home was highly effective, which provides evidence base for.

Systems and Methods for Providing Insulation. Systems and methods provide a multi-layer insulation MLI that includes a plurality of sealed metalized volumes in a stacked arrangement, wherein the plurality of sealed metalized volumes encapsulate a gas therein, with the gas having one of a thermal insulating property, an acoustic insulating property, or a combination insulating property thereof. The MLI also includes at least one spacer between adjacent sealed metalized volumes of the plurality of sealed metalized volumes and a protective cover surrounding the plurality of sealed metalized volumes.

Estimates shows exclusive breastfeeding EBF has the potential to prevent This study aimed at examining factors that affect EBF practice among women in Muheza district, Tanga region, northeastern Tanzania. A community based cross-sectional study using both qualitative and quantitative methods was conducted from April to June To collect relevant information, a total of women with infants aged months were interviewed using a questionnaire and 12 key informants using in-depth interview guide.

Qualitative data was analyzed using thematic analysis while bivariate and multivariate logistic regression analysis were used assess association between EBF and predictor variables. The prevalence of EBF was The perception that mothers' breast milk is insufficient for child's growth, child being thirsty and the need to introduce herbal medicine for cultural purposes were among the important factors for early mixed feeding.

In multivariate analysis advanced maternal age OR 2. The prevalence of EBF in our study is low compared with the national prevalence. Strategies to target beliefs that breast milk is insufficient for growth need to be strengthened in the community. Demand for HIV counselling services is increasing in developing counties, but there have been few previous studies that describe counsellors' roles and experiences providing HIV-related counselling in developing countries.

Such information can be used to better supervise and support counsellors and thereby improve counselling services. As a sub-study of the Voluntary Counseling and Testing Efficacy Study, we conducted focus groups and individual interviews with 11 counsellors and counselling supervisors providing HIV counselling services in Kenya and Tanzania.

Counsellors told us that their jobs were both rewarding and stressful. In addition to their obligations in the counselling relationship providing information, protecting confidentiality and being non-judgemental , they perceived pressure to provide information and be good role models in their communities.

Additional stresses were related to external economic and political conditions, 'spillover' of HIV issues from their personal lives and providing counselling in a research setting. Counsellor stress might be reduced and their effectiveness and retention improved by 1 allowing work flexibility; 2 providing supportive, non-evaluative supervision; 3 offering alternatives to client behaviour change as the indication of counsellor performance; 4 acknowledging and educating about 'emotional labour' in counselling; 5 providing frequent information updates and intensive training; and 6 encouraging counsellor participation in the development of research protocols.

In-depth interviews were used to explore MNH provider views about motivation and incentives at primary care level in rural Burkina Faso, Ghana and Tanzania. Across the three countries some differences were found in the reasons why people became health workers. This was shown to be interlinked with differences in how the term 'motivation' was understood, and in the views held about remuneration and the status of rural health work. Understandings of the terms and concepts pertaining to motivation differed between the three countries. The training that all levels of MNH providers receive in.

Research evidence is not always being disseminated to healthcare providers who need it to inform their clinical practice. This study compares what is known about ITNs to the related knowledge and practices of healthcare providers in four low- and middle-income countries. Is Development Assistance for Health fungible?

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Findings from a mixed methods case study in Tanzania. The amount of Development Assistance for Health DAH available to low- and middle-income countries has increased exponentially over the past decade. However, there are concerns that DAH increases have not resulted in increased spending on health at the country level. This is because DAH may be fungible, resulting from the recipient government decreasing its contribution to the health sector as a result of external funding. The aim of this research is to assess whether DAH funds in Tanzania are fungible, by exploring government substitution of its own resources across sectors and within the health sector.

Government health expenditure data for the same period were obtained from the Government of Tanzania , World Bank, public expenditure reviews and budget speeches and analysed to assess the degree of government substitution. We found some evidence of substitution of government funds at the health sector and sub-sector levels and two mechanisms through which it takes place: We found fungibility of external funds may not necessarily be detrimental to Tanzania 's development as evidence suggests the funds displaced may be reallocated to education and the mechanisms used by DPs to prevent substitution were largely ineffective.

We recommend DPs engage more effectively in the priority-setting process, not just with the Ministry of Health and Social Welfare MoHSW , but also with the Ministry of Finance, to agree on priorities and mutual funding responsibilities at a macroeconomic level. We also call for. Supply-related drivers of staff motivation for providing intermittent preventive treatment of malaria during pregnancy in Tanzania: Background Since its introduction in the national antenatal care ANC system in Tanzania in , little evidence is documented regarding the motivation and performance of health workers HWs in the provision of intermittent preventive treatment of malaria during pregnancy IPTp services in the national ANC clinics and the implications such motivation and performance might have had on HWs and services' compliance with the recommended IPTp delivery guidelines.

This paper describes the supply-related drivers of motivation and performance of HWs in administering IPTp doses among other ANC services delivered in public and private health facilities HFs in Tanzania , using a case study of Mkuranga and Mufindi districts. Methods Interviews were conducted with 78 HWs participating in the delivery of ANC services in private and public HFs and were supplemented by personal communications with the members of the district council health management team.



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The research instrument used in the data collection process contained a mixture of closed and open-ended questions. Some of the open-ended questions had to be coded in the form that allowed their analysis quantitatively. Results In both districts, respondents acknowledged IPTp as an essential intervention, but expressed dissatisfaction with their working environments constraining their performance, including health facility HF unit understaffing; unsystematic and unfriendly supervision by CHMT members; limited opportunities for HW career development; and poor HF infrastructure and staff houses.

Data also suggest that poor working conditions negatively affect health workers' motivation to perform for ANC including IPTp services. Perspectives of healthcare providers in Dar es Salaam, Tanzania. The specific age to which an HIV infected child can be disclosed to is stipulated to begin between ages 4 and 6 years. It has also been documented that before disclosure of HIV positive status to the infected child.

Health care providers should consider children's cognitive-developmental ability. However, observation and situation analysis show that, health care providers still feel uncomfortable disclosing the HIV positive status to the infected child. The aim of the study was to explore healthcare providers ' experiences in disclosure of HIV-positive status to the infected child. A qualitative study involving 20 health care providers who attend HIV-positive children was conducted in September, in Dar es Salaam, Tanzania.

An interview guide, translated into participants' national language Kiswahili was used during in-depth interviews. Sampling followed the principle of data saturation. The interviews focused on perspectives of health-care providers regarding their experience with paediatric HIV disclosure. Data from in-depth interviews were transcribed into text; data analysis followed qualitative content analysis.

The results show how complex the process of disclosure to children living with HIV can be to healthcare providers. Confusion was noted among healthcare providers about their role and responsibility in the process of disclosing to the HIV infected child. This was reported to be largely due to unclear guidelines and lack of standardized training in paediatric HIV disclosure. Furthermore, healthcare providers were concerned about parental hesitancy to disclose early to the child due to lack of disclosure skills and fear of stigma.

In order to improve the disclosure process in HIV infected children, healthcare providers recommended further standardized training on paediatric HIV disclosure with more emphasis on practical skills and inclusion of disclosure. The challenges of developing an instrument to assess health provider motivation at primary care level in rural Burkina Faso, Ghana and Tanzania.

Prytherch, Helen; Leshabari, Melkidezek T. Background The quality of health care depends on the competence and motivation of the health workers that provide it. In the West, several tools exist to measure worker motivation, and some have been applied to the health sector. However, none have been validated for use in sub-Saharan Africa. The complexity of such tools has also led to concerns about their application at primary care level. Objective To develop a common instrument to monitor any changes in maternal and neonatal health MNH care provider motivation resulting from the introduction of pilot interventions in rural, primary level facilities in Ghana, Burkina Faso, and Tanzania.

Design Initially, a conceptual framework was developed. Based upon this, a literature review and preliminary qualitative research, an English-language instrument was developed and validated in an iterative process with experts from the three countries involved. The instrument was then piloted in Ghana. Reliability testing and exploratory factor analysis were used to produce a final, parsimonious version.

Results and discussion This paper describes the actual process of developing the instrument. Consequently, the concepts and items that did not perform well psychometrically at pre-test are first presented and discussed. The final version of the instrument, which comprises 42 items for self-assessment and eight for peer-assessment, is then shown. This is followed by a presentation and discussion of the findings from first use of the instrument with MNH providers from 12 rural, primary level facilities in each of the three countries. Conclusions It is possible to undertake work of this nature at primary health care level, particularly if the instruments are kept as straightforward as possible and well introduced.

However, their development requires very lengthy preparatory periods. The effort needed to adapt such instruments for use in different countries within the region of sub-Saharan Africa should not be underestimated. Factors influencing job preferences of health workers providing obstetric care: Task shifting from established health professionals to mid-level providers MLPs professionals who undergo shorter training in specific procedures is one key strategy for reducing maternal and neonatal deaths.

This has resulted in a growth in cadre types providing obstetric care in low and middle-income countries. Little is known about the relative importance of the different factors in determining motivation and retention amongst these cadres. This paper presents findings from large sample respondents discrete choice experiments to examine the employment preferences of obstetric care workers across three east African countries. The strongest predictors of job choice were access to continuing professional development and the presence of functioning human resources management transparent, accountable and consistent systems for staff support, supervision and appraisal.

Consistent with similar works we find pay and allowances significantly positively related to utility, but financial rewards are not as fundamental a factor underlying employment preferences as many may have previously believed. Location urban vs rural had the smallest average effect on utility for job choice in all three countries. These findings are important in the context where efforts to address the human resources crisis have focused primarily on increasing salaries and incentives, as well as providing allowances to work in rural areas. The internal migration between public and faith-based health providers: To assess the magnitude, direction and underlying dynamics of internal health worker migration between public and faith-based health providers from a hospital perspective.

Two complementary tools were implemented in 10 public and six faith-based hospitals in southern Tanzania. A hospital questionnaire assessed magnitude and direction of staff migration between January and June Interviews with 42 public and 20 faith-based maternity nurses evaluated differences in staff perspectives and motives for the observed migration patterns.

The predominant direction of staff movement was from the faith-based to the public sector: Nurses were the largest group among the migrating health workforce. Faith-based hospitals lost Interviews revealed significantly inferior staff perspectives among faith-based respondents than their public colleagues. Main differences were identified regarding career development and training, management support, employee engagement and workload. This study revealed considerable internal health worker migration from the faith-based to the public sector.

Staff retention and motivation within faith-based hospitals are not restricted to financial considerations, and salary gaps can no longer uniquely explain this movement pattern. The consequences for the catchment area of faith-based hospitals are potentially severe and erode cooperation potential between the public and private health sector.

Evaluation of collection methods for Culex quinquefasciatus, Aedes aegypti, and Aedes simpsoni in northeastern Tanzania. In East Africa, significant morbidity and mortality are caused by infections spread by Culex quinquefasciatus and Aedes aegypti. Sticky traps have been shown to be effective tools for sampling populations of Aedes mosquitoes and have been found to catch Cx. Thus, they could potentially be used to sample populations of this species.

A follow-up experiment was carried out using traps set for a h period to accommodate the oviposition habits of Aedes aegypti and Ae. All three trap types should be considered for monitoring Aedes mosquitoes. Child Sexual Abuse in Tanzania and Kenya. Most research on child abuse in Tanzania and Kenya is unpublished in the international literature. The purpose of this paper is to examine the various commentaries and reports extant, toward an overview of the nature and frequency of child sexual abuse in Tanzania and Kenya.

Contacts were made with academics, government…. Comparison of detection methods to estimate asexual Plasmodium falciparum parasite prevalence and gametocyte carriage in a community survey in Tanzania. The use of molecular techniques to detect malaria parasites has been advocated to improve the accuracy of parasite prevalence estimates, especially in moderate to low endemic settings. Molecular work is time-consuming and costly, thus the effective gains of this technique need to be carefully evaluated.

Light microscopy LM and rapid diagnostic tests RDT are commonly used to detect malaria infection in resource constrained areas, but their limited sensitivity results in underestimation of the proportion of people infected with Plasmodium falciparum. This study aimed to evaluate the extent of missed infections via a community survey in Tanzania , using polymerase chain reaction PCR to detect P.

Three hundred and thirty individuals of all ages from the Kilombero and Ulanga districts Tanzania were enrolled in a cross-sectional survey. Gametocytes were detected by LM and by amplifying transcripts of the gametocyte-specific marker pfs Results from all three diagnostic methods were available for a subset of individuals. Gametocyte prevalence was Thus, LM is not a sufficiently accurate technique from which to inform policies and malaria control or elimination efforts. However, it is also insufficient when precise prevalence data are needed for monitoring intervention success or for determining point prevalence rates in countrywide surveillance.

Does training on performance based financing make a difference in performance and quality of health care delivery? Health care provider 's perspective in Rungwe Tanzania. In recent years, Performance Based Financing PBF ; a form of result based financing, has attracted a global attention in health systems in developing countries.

PBF promotes autonomous health facilities, motivates and introduces financial incentives to motivate health facilities and health workers to attain pre-determined targets. This was an explorative qualitative study, which took place at Rungwe PBF pilot area in October Twenty six 26 participants were purposively selected. Six took part in- depth interviews IDIs and twenty 20 in the group discussions. Data were manually analyzed using content analysis approach. Overall informants had positive perspectives on PBF training. Most of the health facilities were able to implement some of the PBF concepts in their work places after the training, such as developing job descriptions for their staff, creating quarterly business plans for their facilities, costing for their services and entering service agreement with the government, improved record keeping, customer care and involving community as partners in running their facilities.

The most common principle of paying individual performance bonuses was mentioned as a major challenge due to inadequate funding and poor design of Rungwe PBF pilot project. Despite poor design and inadequate funding, our findings have shown some promising results after PBF training in the study area. The findings have highlighted. To improve access to treatment in the private retail sector a new class of outlets known as accredited drug dispensing outlets ADDO was created in Tanzania.

Conventialization of Numerals in Tanzania. The supposed pre-eminence of an external examination can exert a disproportionate influence on a curriculum and the associated learning and teaching. Teaching can easily subordinate learning and understanding to curriculum coverage if the society develops a culture that appears to make such demands. This study focuses on Tanzania and provides the…. The TSP will furnish the information described in this Anti-mosquito plants as an alternative or incremental method for malaria vector control among rural communities of Bagamoyo District, Tanzania.

Background Plants represent one of the most accessible resources available for mosquito control by communities in Tanzania. However, no documented statistics exist for their contribution in the management of mosquitoes and other insects except through verbal and some publications. Methods Questionnaires were administered to respondents from four villages of Bagamoyo District, Pwani Region, in Tanzania followed by participatory rural appraisal with village health workers. Results Results showed about Majority of respondents collected these plants from the wild Most respondents were aware that mosquitoes transmit malaria